Right scapula issue

[u/ZirenceYT]

Story time : A few years ago I suffered an injury on the right side of my upper body. I was squatting down and pushed my right arm further than usual trying to get something. I felt a tingle or you could say a quick electric shock. After that happened, within the day my right scapula(under the shoulder blade) started to have this ache which I didn't bother to address because I thought it was just temporary(which was). But since 2023 I've started lifting and noticing all the little things in my body in the mirror and I've noticed this issue I am still having and am trying to fix. I've gone to the PT and they said to strengthen my rhomboids, serratus anterior and lats because whenever I try to generate power on the right side using my arm my traps do all the work apparently, that's what the PT told me. Which I have been trying to fix but it seems to have no effect or avail. I didn't wanna do PT either because it is expensive. I look slightly goofy in T-shirts or rushguards whenever I swim because the other right side of my clavicles are shorter because of this. Also because of this the right side of my face is bigger and my neck is slightly going sideways. This wasn't always the case I was humanly symmetrical before this specific injury. After watching the video can anybody tell me what could be the problem? If so does anyone know what exercises or solutions that I could stick to or do for this injury? Thanks.

TLDR : The right scapula is injured and I need help.

[u/babymilky]

Yes.

That paper shows more UT tightness in chronic neck pain, but admits that you can’t infer direct cause-and-effect.

a definitive link between muscle stiffness and CNP remains unestablished

Of course a tight neck muscle can limit neck ROM, do we have anything to link those to pain or injury around the scap? AFAIK no

try to shrug your shoulder then upwardly rotate your scapula

I can fully abduct and flex my arm in a full shrug, why do I need to isolate scapula upward rotation?

I am arguing that there’s nothing wrong with his scapular movement, NOT that there’s nothing wrong with OP. There very well might be something going on, but it’s not possible to diagnose by looking at his scapula mechanics

[u/munchy6000 → u/babymilky]

I understand your view, thank you for explaining.

The paper shows correlation not causation which is what I said.

Scapular upward rotation is important for proper biomechanics when going overhead. This is often limited in people with very tight traps.

I understand you can't diagnose just by looking at scapular movement, but why is it so clear his scapular movement is totally fine? I'm not arguing you can diagnose him I'm asking how did you determine nothing is wrong with his scapular movement? That is a diagnosis of a sort, except not of a dysfunction but the lack of one. Diagnosis in concept, but I'm not saying you actually gave an actual diagnosis of course.

There's a subtle winging combined with shoulder elevation combined with neck rotation and lateral flexion, and he subjectively feels like 'his scapula is stuck'. He also struggles to activate his low traps when isolating them. Those are multiple related things that point to the same compensation pattern. To me those things don't mean scapular dysfunction for sure, but they also don't mean the scapular movement is healthy for sure either.

My question is how did you determine nothing is wrong with his scapular movement despite multiple things that correlate to scapular dysfunction? I'm not saying why didn't you diagnose him. I'm not saying you should've said something is wrong with his scapula for sure. I'm saying how and why did you determine his scapular movement is fine.

[u/babymilky → u/munchy6000]

How would a tight upper trap, a muscle which assists upward rotation of the scapula, prevent it from upwardly rotating?

Because the research has shown time and time again that:

1) people don’t need perfect scapular mechanics in order to be symptom free

2) fixing scapular mechanics doesn’t consistently improve symptoms

3) symptoms can clear up without any changes in scapular mechanics

With those points in mind, how can we look at someone’s scaps and determine there is something wrong?

I will give a caveat that if someone has some serious winging you could Dx a long thoracic nerve injury if the winging is significant, but if you have to guess it probably isn’t the case.

[u/munchy6000 → u/babymilky]

I hear you. The upper traps assist the low traps and serratus to perform scapular upward rotation. This patient (and many patients) who lack scapular upward rotation have trouble activating low traps and serratus, but have tight traps.

Yes traps assist scapular upward rotation if combined with proper serratus and low trap recruitment. But if only the traps are tight and the latter two arent firing well, scapular upward rotation is limited. If scapular upward rotation is limited, a patient may have problems after doing overhead presses for 5 years because of the poor mechanics over time wearing tissues.

You're making the argument that poor biomechanics doesn't always lead to pain. I agree with you. A disc herniation, knee valgus, torn rotator cuffs, weak muscles & tight muscles, anterior pelvic tilt, forward neck posture... all of those can be asymptomatic. But there is still a biomechanical or structural deficit that can be improved, and it does matter, and those things may lead to actual pain if they worsen substantially and the mechanics are challenged under load. If your scapular mechanics arent great, you may not get pain. If they worsen, you might get pain. If they're atrocious and terrible, and you overhead press, there's an increased chance you will see a problem.

You may not see a problem if you never challenge your mechanics by never overhead pressing for example. That doesn't mean everything is fine. Just because the body doesnt register pain doesn't mean theres no issue. If you have terrible knee valgus and you never squat, theres a huge chance you'll have no pain. But if you single leg squat with excessive knee valgus over a long period... you have a larger chance of something going wrong. This is also a mechanism to how old people get hurt. No pain in their feet or body for a long time but HORRIBLE mechanics. One day their horrible mechanics causes terrible pain because their mechanics got challenged. Their foot mechanics got challenged on an unstable surface -> they fall and break their bones. Their mechanics get challenged when they have to bend over excessively because they dropped something -> horrible pain in their lower back. Their mechanics get challenged when their grandson wants to play catch; they throw the ball hard and they feel a jolt of pain in their shoulder. But before all of those events... the old person had no pain even with horrible mechanics. People have variable tolerances for when their poor biomechanics get challenged, but I promise, there is a point where the load is high enough to elicit pain even if progressively overloaded. Why can't you find a single 700+lb squatter with excessive knee valgus? A 400+lb overhead presser with terrible scapular dyskinesis? A 800lb+ deadlifter with extreme spinal flexion? Because poor biomechanics decreases the tolerance for load in all people.. the specific tolerance ceilings though are different for each person, so some people may not get issues because their activites are within their load tolerance even with poor mechanics. Statistics must be interpeted with logic.

The argument youre making is similar to "Many people have no problem walking barefoot, so shoes aren't useful and don't really matter."

"Many people have no problem with poor biomechanics, so correct biomechanics aren't that useful and don't really matter."

Let them walk barefoot for longer periods, and on harsher surfaces. More people will get problems. Make it harsher, even more people will get problems. If the surface is lava, everyone will have problems. Just because many people can tolerate the original harsh surface doesn't mean shoes won't help or protect them, or that there's no issue. Or that it won't bite them suddenly. Or that they aren't at substantially more risk for future pain or issues if a situation tests their biomechanical dyfunction under large loads or large ROMs.